Pharmaceutical combination

ABSTRACT

A pharmaceutical combination comprising as components (a) at least one 3-(3-dimethylamino-1-ethyl-2-methyl-propyl)-phenol compound, and (b) at least one NMDA-antagonist, a pharmaceutical formulation and a dosage form comprising such a combination, and a method of treating pain, e.g. inflammatory pain or neuropathic pain, in which components (a) and (b) are administered simultaneously or sequentially to a mammal, with component (a) being administered either before or after component (b), and with components (a) or (b) being administered to the mammal either via the same pathway of administration or via different pathways of administration.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.14/315,603, filed Jun. 26, 2014, which is a continuation of U.S. patentapplication Ser. No. 13/159,845, filed Jun. 14, 2011, which claimsbenefit of provisional patent application Ser. No. 61/354,835 andEuropean patent application no. EP 10 006 202.5, both filed Jun. 15,2010 and incorporated herein by reference.

BACKGROUND OF THE INVENTION

The present invention relates to a combination comprising as components(a) at least one 3-(3-dimethylamino-1-ethyl-2-methyl-propyl)-phenolcompound, and (b) at least one N-methyl-D-aspartate antagonist(NMDA-antagonist), a pharmaceutical formulation and a dosage formcomprising said combination as well as a method of treating pain, e.g.inflammatory pain or neuropathic pain, wherein components (a) and (b)are administered simultaneously or sequentially to a mammal, wherebycomponent (a) may be administered before or after component (b) andwhereby components (a) or (b) are administered to the mammal either viathe same or a different pathway of administration.

The treatment of chronic and acute pain conditions is extremelyimportant in medicine. There is currently a worldwide demand foradditional, not exclusively opioid-based, but highly effective paintreatment. The urgent need for action for patient-oriented andpurposeful treatment of pain conditions, this being taken to mean thesuccessful and satisfactory treatment of pain for the patient, isdocumented in the large number of scientific papers that have recentlyappeared in the field of applied analgesics and fundamental researchwork on nociception.

Even if the analgesics that are currently used for treating pain, forexample opioids, NA- and 5HT-reuptake inhibitors, NSAIDS and COXinhibitors, are analgesically effective, side effects neverthelesssometimes occur. Sometimes substance combinations comprising twodifferent drugs show super-additive therapeutic effects uponadministration. Due to such a super-additive effect the overall dose andaccordingly the risk of undesired side effects can be reduced. Examplesof combinations comprising3-(3-dimethylamino-1-ethyl-2-methyl-propyl)-phenol are disclosed in US2009/099138 (=WO 2007/128412), US 2007/254960 (=WO 2007/128413) and US2010/190752 (=WO 2010/025931).

SUMMARY OF THE INVENTION

Thus, it was an object of the present invention to provide furthercombinations having improved properties.

It was also an object of the present invention to find furthercombinations that are suitable for the treatment of pain and thatpreferably exhibit fewer undesired side effects compared to itsindividual components, if administered in effective doses.

It has been found that a combination comprising (a) at least one3-(3-dimethylamino-1-ethyl-2-methyl-propyl)-phenol compound, and (b) atleast one NMDA-antagonist exhibits an analgesic effect. If thesecomponents are present in the composition in such a weight ratio that asuper-additive or synergistic therapeutic effect is observed uponadministration to the patients, the overall administered dose may belowered, so that fewer undesired side-effects will occur.

Accordingly, the present invention relates to a pharmaceuticalcombination comprising as components

-   (a) 3-(3-dimethylamino-1-ethyl-2-methyl-propyl)-phenol of formula    (I)

-   -   optionally in form of one of its pure stereoisomers, in        particular an enantiomer or a diastereomer, a racemate or in        form of a mixture of its stereoisomers, in particular        enantiomers and/or diastereomers in any mixing ratio, or any        corresponding acid addition salt thereof, and

-   (b) at least one NMDA-antagonist.

In one embodiment of the pharmaceutical combination according to theinvention, the compound of formula (I) is selected from

-   (1R,2R)-3-(3-dimethylamino-1-ethyl-2-methyl-propyl)-phenol,-   (1S,2S)-3-(3-dimethylamino-1-ethyl-2-methyl-propyl)-phenol,-   (1R,2S)-3-(3-dimethylamino-1-ethyl-2-methyl-propyl)-phenol,-   (1S,2R)-3-(3-dimethylamino-1-ethyl-2-methyl-propyl)-phenol, and any    mixture thereof.

In another embodiment of the pharmaceutical combination of theinvention, the compound of formula (I) is selected from

-   (1R,2R)-3-(3-dimethylamino-1-ethyl-2-methyl-propyl)-phenol, and-   (1S,2S)-3-(3-dimethylamino-1-ethyl-2-methyl-propyl)-phenol, and any    mixture thereof.

In yet another embodiment, the pharmaceutical combination of theinvention comprises

-   (a) the compound    (1R,2R)-3-(3-dimethylamino-1-ethyl-2-methyl-propyl)-phenol of    formula (I′),

-   -   or an acid addition salt thereof, and

-   (b) at least one NMDA-antagonist.

The compound 3-(3-dimethylamino-1-ethyl-2-methyl-propyl)-phenol offormula (I), its stereoisomers and corresponding salts thereof as wellas methods for their preparation are well known, for example, from U.S.Pat. No. 6,248,737, the entire disclosure of which is incorporatedherein by reference.

The definition of component (a) as used herein includes3-(3-dimethylamino-1-ethyl-2-methyl-propyl)-phenol, derivatives thereofand stereoisomers thereof in any possible form, thereby particularlyincluding solvates and polymorphs, salts, in particular acid additionsalts and corresponding solvates and polymorphs.

The term derivative as used herein particularly includes prodrugs suchas ethers and esters of the active substance. Suitable methods forselecting and preparing a pro-drug of a given substance are for exampledescribed in “Textbook of Drug Design and Discovery”, 3^(rd) edition,2002, chapter 14, pages 410-458, Editors: Krogsgaard-Larsen et al.,Taylor and Francis. The respective parts of said literature descriptionare incorporated by reference and form part of the present disclosure.

If component (a) is present as mixture of enantiomers, such a mixturemay contain the enantiomers in racemic or non-racemic form. Anon-racemic form could, for example, contain the enantiomers in a ratioof 60±5:40±5, 70±5:30±5, 80±5:20±5 or 90±5:10±5.

The compound 3-(3-dimethylamino-1-ethyl-2-methyl-propyl)-phenol and itsstereoisomers according to component (a) may be present in thepharmaceutical composition of the present invention in form of an acidaddition salt, whereby any suitable acid capable of forming such anaddition salt may be used.

The conversion of 3-(3-dimethylamino-1-ethyl-2-methyl-propyl)-phenolinto a corresponding addition salt, for example, via reaction with asuitable acid may be effected in a manner well known to persons skilledin the art. Suitable acids include, but are not limited to, hydrochloricacid, hydrobromic acid, sulfuric acid, methanesulfonic acid, formicacid, acetic acid, oxalic acid, succinic acid, tartaric acid, mandelicacid, fumaric acid, lactic acid, citric acid, glutamic acid and/oraspartic acid. Salt formation is preferably effected in a solvent, forexample, diethyl ether, diisopropyl ether, alkyl acetates, acetoneand/or 2-butanone. Moreover, trimethylchlorosilane in aqueous solutionis also suitable for the preparation of hydrochlorides.

The NMDA receptor is part of a glutamatergic neurotransmitter-receptorsystem, the so-called NMDA-receptor/ion-channel complex. It comprisesdifferent binding sites that are located inside and outside of theion-channel. An NMDA receptor antagonist or simply NMDA-antagonist is asubstance that interacts with such a binding site and exerts at leastpartially inhibiting properties related to said binding site.

NMDA-antagonists are well known to those skilled in the art andparticularly include, without being limited thereto, N-containingphosphonic acids, such as norvaline (AP5), D-norvaline (D-AP5),4-(3-phosphono-propyl)-piperazine-2-carboxylic acid (CPP),D-(E)-4-(3-phosphonoprop-2-enyl)piperazine-2-carboxylic acid (D-CPPene),cis-4-(phosphonomethyl)-2-piperidine carboxylic acid (Selfotel, CGS19755), SDZ-220581, PD-134705, LY-274614 and WAY-126090; quinolinicacids, such as kynurenic acid, 7-chloro-kynurenic acid,7-chloro-thiokynurenic acid and 5,7-dichloro-knynurenic acid, prodrugsthereof, such as 4-chlorokynurenine and 3-hydroxy-kynurenine; 4-aminotetrahydrochinolin-carboxylates, such as L-689,560;4-hydroxyquinolin-2(1H)-ones, such as L-701,324; quinoxalinediones, suchas licostinel (ACEA-1021) and CGP-68,730A;4,6-dichloro-indole-2-carboxylate derivatives such as MDL-105,519,gavestinel (GV-150,526) and GV-196,771A; tricyclic compounds, such asZD-9,379 and MRZ-2/576, (+)-HA-966, morphinan derivatives such asdextromethorphan and dextrophan; benzomorphans, such as BIII-277CL;other opioids, such as dextropropoxyphene, ketobemidone, dextromethadoneand D-morphine; amino-adamantanes, such as amantadine and memantine;amino-alkyl-cyclohexanes, such as MRZ-2/579; ifenprodil andifenprodile-like compounds such as eliprodil and PD-196,860;iminopyrimidines; or other NMDA-antagonists such as nitroprusside,D-cycloserine, 1-am inocyclopropane-carboxylic acid, dizocilpine (MK801) and its analogs, phencyclidine (PCP), ketamine((R,S)-2-(2-Chlorphenyl)-2-(methylam ino)cyclohexan-1-on), (R)-ketamine,(S)-ketamine, remacem ide and its des-glycinyl-metabolite FPL-12,495,AR-R-15,896, methadone, sulfazocine, AN19/AVex-144, AN2/AVex-73,Besonprodil, CGX-1007, EAB-318, Felbamate and NPS-1407. NMDA-Antagonistsare, for example, disclosed in “Analgesics,” edited by H. Buschmann, T.Christoph, E. Friderichs, C. Maul, B. Sundermann, 2002, Wiley-VCH VerlagGmbH & Co. KGaA, Weinheim, Germany, in particular pages 389-428. Therespective parts of the description are hereby incorporated by referenceand form part of the present disclosure.

Some NMDA-antagonists such as ketamine and memantine are known to beuseful in the treatment of neuropathic pain. In one embodiment of thepresent invention one or more of these NMDA-antagonists is used ascomponent (b).

Also included are stereoisomers, salts, solvates, polymorphs andderivatives of the NMDA-antagonist component as well as mixtures of anyof the foregoing.

In another embodiment of the pharmaceutical combination of theinvention, the NMDA-antagonist according to component (b) is memantineor an acid addition salt thereof such as the hydrochloride additionsalt.

In a further embodiment of the pharmaceutical combination of theinvention, the NMDA-antagonist according to component (b) is ketamine oran acid addition salt thereof such as the hydrochloride addition salt.

In yet another embodiment of the pharmaceutical combination of theinvention, the NMDA-antagonist according to component (b) is(R,S)-ketamine or an acid addition salt thereof such as thehydrochloride addition salt.

In still another embodiment of the pharmaceutical combination of theinvention, the NMDA-antagonist according to component (b) is(S)-ketamine or an acid addition salt thereof such as the hydrochlorideaddition salt.

Another specific embodiment of the present invention is a combinationcomprising (a)(1R,2R)-3-(3-dimethylamino-1-ethyl-2-methyl-propyl)-phenol, or an acidaddition salt thereof such as the hydrochloride addition salt, and (b)memantine or an acid addition salt thereof such as the hydrochlorideaddition salt.

Yet another specific embodiment of the present invention is acombination comprising (a)(1R,2R)-3-(3-dimethylamino-1-ethyl-2-methyl-propyl)-phenol, or an acidaddition salt thereof such as the hydrochloride addition salt, and (b)ketamine or an acid addition salt thereof such as the hydrochlorideaddition salt.

Yet a further specific embodiment of the present invention is acombination comprising (a)(1R,2R)-3-(3-dimethylamino-1-ethyl-2-methyl-propyl)-phenol, or an acidaddition salt thereof such as the hydrochloride addition salt, and (b)(R,S)-ketamine or an acid addition salt thereof such as thehydrochloride addition salt.

Yet still another specific embodiment of the present invention is acombination comprising (a)(1R,2R)-3-(3-dimethylamino-1-ethyl-2-methyl-propyl)-phenol, or an acidaddition salt thereof such as the hydrochloride addition salt, and (b)(S)-ketamine or an acid addition salt thereof such as the hydrochlorideaddition salt.

Some NMDA-antagonists comprise functional groups, for example, acidicgroups such as carboxy groups which are capable of forming salts withthe 3-(3-dimethylamino-1-ethyl-2-methyl-propyl)-phenol component offormula (I), thereby incorporating both components (a) and (b) in oneand the same salt.

Thus, in another embodiment of the present invention the pharmaceuticalcombination of the invention comprises components (a) and (b) in form ofa salt formed from these two components. Such a salt formation may bepartial, i.e. the composition of the invention comprises one or both ofthese components also in their non-salt form, or the salt formation mayessentially be complete.

Both components (a) and (b) as part of the pharmaceutical combination ofthe invention may be administered in amounts up to their maximum dailydosage, which is known to persons skilled in the art.

Memantine may preferably be administered to a patient in a daily dosageof 1 to 20 mg.

Racemic ketamine may preferably be administered to a patient in a dailydosage of 0.1 to 10 mg/kg, and the S-enantiomer of ketamine maypreferably be administered to a patient in a daily dosage of 1 to 10mg/kg.

The compound (1R,2R)-3-(3-dimethylamino-1-ethyl-2-methyl-propyl)-phenolmay preferably be administered to a patient in a daily dosage of 25 to1000 mg, particularly preferably in a dosage of 50 to 800 mg, moreparticularly preferably in a dosage of 100 to 600 mg.

When administered as part of the combination according to the presentinvention, the administered amount per day of component (a) and/orcomponent (b) may be less than the respective maximum daily dosage andbe, for example, 75±15 wt.-%, 75±10 wt.-%, 75±5 wt.-%, 50±15 wt.-%,50±10 wt.-%, 50±5 wt.-%, 25±15 wt.-%, 25±10 wt.-% and 25±5 wt.-% foreach of the components.

In another embodiment of the present invention the pharmaceuticalcombination of the invention may contain components (a) and (b)essentially in an equieffective ratio.

In yet a further embodiment of the combination according to theinvention, components (a) and (b) are present in such a weight ratiothat the resulting composition will exert a supra-additive orsynergistic effect upon administration to a patient. Suitable weightratios can be determined by methods well known to those skilled in theart.

Both components (a) and (b) may also be present in the pharmaceuticalcombination of the invention in ratios deviating from the equieffectiveratio. For, example, each of the components could be present in a rangefrom 1/50 of the equieffective amount to 50 times the equieffectiveamount, from 1/20 of the equieffective amount to 20 times theequieffective amount, from 1/10 of the equieffective amount to 10 timesthe equieffective amount, from 1/5 of the equieffective amount to 5times the equieffective amount, from 1/4 of the equieffective amount to4 times the equieffective amount, from 1/3 of the equieffective amountto 3 times the equieffective amount, or from 1/2 of the equieffectiveamount to 2 times the equieffective amount.

In another embodiment of the present invention the components (a) and(b) can be administered in a specific dosage regimen to treat pain, forexample, neuropathic pain. Components (a) and (b) may be administeredsimultaneously or sequentially one after another, in each case via thesame or different administration pathways.

Another aspect of the present invention is therefore a method oftreating pain, characterized in that components (a) and (b) areadministered simultaneously or sequentially to a mammal, whereincomponent (a) may be administered before or after component (b), andwherein components (a) or (b) are administered to the mammal either viathe same or a different pathway of administration.

The term pain as used herein includes but is not limited to inflammatorypain, neuropathic pain, acute pain, chronic pain, visceral pain,migraine pain and cancer pain.

Suitable pathways of administration include, but are not limited to,oral, intravenous, intraarterial, intraperitoneal, intradermal,transdermal, intrathecal, intramuscular, intranasal, transmucosal,subcutaneous, and rectal administration.

The combinations according to the invention are toxicologically safe andare therefore suitable for the treatment of mammals, particularly humansincluding infants, children and adults.

Thus, in a further aspect the present invention relates to apharmaceutical composition comprising a pharmaceutical combinationaccording to the invention as described herein and one or more auxiliaryagents.

In a further aspect the present invention relates to a pharmaceuticaldosage form comprising a pharmaceutical combination of the invention asdescribed herein and one or more auxiliary agents.

In one embodiment, the pharmaceutical dosage form of the invention issuitable for being administered orally, intravenously, intraarterially,intraperitoneally, intradermally, transdermally, intrathekally,intramuscularly, intranasally, transmucosally, subcutaneously, orrectally.

The formulations and dosage forms of the invention may contain auxiliaryagents, for example, carriers, fillers, solvents, diluents, colorantsand/or binders. The selection of auxiliary agents and of the amounts ofthe same to be used depends, for example, on how the drug is to beadministered, e.g. orally, intravenously, intraarterially,intraperitoneally, intradermally, transdermally, intramuscularly,intranasally or locally, for example for infections of the skin, of themucous membranes or of the eye.

Suitable auxiliary agents in the context of this invention include, inparticular, any substances known to persons skilled in the art to beuseful for the preparation of galenical formulations. Examples ofsuitable auxiliary agents include, but are not limited to, water,ethanol, 2-propanol, glycerol, ethylene glycol, propylene glycol,polyethylene glycol, polypropylene glycol, glucose, fructose, lactose,saccharose, dextrose, molasses, starch, modified starch, gelatine,sorbitol, inositol, mannitol, microcrystalline cellulose, methylcellulose, carboxymethyl cellulose, cellulose acetate, shellac, cetylalcohol, polyvinyl pyrrolidone, paraffins, waxes, natural and syntheticgums, acacia gum, alginates, dextran, saturated and unsaturated fattyacids, stearic acid, magnesium stearate, zinc stearate, glycerolstearate, sodium lauryl sulphate, edible oils, sesame oil, coconut oil,peanut oil, soybean oil, lecithin, sodium lactate, polyoxyethylene andpolypropylene fatty acid ester, sorbitan fatty acid ester, sorbic acid,benzoic acid, citric acid, ascorbic acid, tannic acid, sodium chloride,potassium chloride, magnesium chloride, calcium chloride, magnesiumoxide, zinc oxide, silicon dioxide, titanium oxide, titanium dioxide,magnesium sulphate, zinc sulphate, calcium sulphate, potash, calciumphosphate, dicalcium phosphate, potassium bromide, potassium iodide,talcum, kaolin, pectin, crosspovidone, agar and bentonite.

Pharmaceutical formulations or dosage forms in the form of tablets,effervescent tablets, chewing tablets, dragees, capsules, drops, juicesor syrups are, for example, suitable for oral administration. Oralpharmaceutical formulations may also be in the form of multiparticulatessuch as granules, pellets, spheres, crystals and the like, optionallycompressed into a tablet, filled into a capsule, filled into a sachet orsuspended in a suitable liquid medium. Oral pharmaceutical formulationsmay also be provided with an enteric coating.

Pharmaceutical formulations that are suitable for parenteral, topicaland inhalative administration include but are not limited to solutions,suspensions, easily reconstitutable dry preparations and sprays.

Suppositories are a suitable pharmaceutical formulation for rectaladministration. Formulations in a deposit, in dissolved form, forexample, in a patch optionally with the addition of agents to promoteskin penetration, are examples of suitable formulations for percutaneousadministration.

One or both of the components (a) and (b) may be present in thepharmaceutical formulation according to the invention at least partiallyin controlled-release form. Moreover, any controlled release/immediaterelease combination of the components may also be present in thepharmaceutical formulation of the invention. For example, one or both ofthe components may be released from the formulations of the inventionwith a certain delay, e.g. if administered orally, rectally orpercutaneously. Such formulations are particularly useful for“once-daily” or “twice-daily” preparations, which only have to be takenonce a day, respectively, twice a day. Suitable controlled-releasematerials are well known to persons skilled in the art.

The pharmaceutical formulations of the invention may be produced usingmaterials, means, devices and processes that are well known in the priorart of pharmaceutical formulations, as described for example in“Remington's Pharmaceutical Sciences”, A. R. Gennaro (ed.), 17^(th)edition, Mack Publishing Company, Easton, Pa. (1985), in particular inpart 8, chapters 76 to 93.

In order to obtain a solid pharmaceutical formulation such as a tablet,for example, the components of the pharmaceutical composition may begranulated with a pharmaceutical carrier, for example conventionaltablet ingredients such as corn starch, lactose, saccharose, sorbitol,talcum, magnesium stearate, dicalcium phosphate or pharmaceuticallyacceptable gums, and pharmaceutical diluents, for example water, inorder to form a solid composition that contains the components inhomogeneous distribution. The term “homogeneous distribution” is takento mean that the components are distributed uniformly over the entirecomposition, so that said composition may easily be divided into equallyeffective unit dose forms, such as tablets, pills or capsules and thelike. The solid composition is then divided into unit dose forms. Thetablets or pills of the pharmaceutical composition according to theinvention may also be coated or compounded in a different manner, inorder to provide a dose form with a controlled release.

If one of the components is to be released prior to the other component,for example at least 30 minutes or 1 hour beforehand, pharmaceuticalformulations having a corresponding release profile may be prepared. Anexample of such a formulation is an osmotically driven release systemfor achieving a delayed release of one component via a coating thatitself contains the other component which is accordingly releasedearlier. In a release system of this kind, which is particularlysuitable for oral administration, at least part, and preferably all, ofthe surface of the release system, preferably those parts that will comeinto contact with the release medium, is/are semipermeable, preferablyequipped with a semipermeable coating, so the surface(s) is/arepermeable to the release medium, but substantially, preferably entirely,impermeable to the active ingredient, the surface(s) and/or optionallythe coating comprising at least one opening for releasing the activeingredient. Moreover, precisely that/those surface(s) that is/are incontact with the release medium is/are provided with a coatingcontaining and releasing the other component. This is preferably takento mean a system in tablet form comprising a release opening, an osmoticpharmaceutical composition core, a semipermeable membrane and a polymerportion that exerts pressure upon swelling. A suitable example of thiskind of system is the system distributed by ALZA Corporation, USA underthe tradenames OROS®, in particular, the OROS® Push-Pull™ System, theOROS® Delayed Push-Pull™ System, the OROS® Multi-Layer Push-Pull™system, the OROS® Push-Stick System and also, in specific cases, theL-OROS™. Embodiments and examples of osmotically driven release systemsare disclosed, for example, in U.S. Pat. Nos. 4,765,989, 4,783,337 and4,612,008, the entire disclosures of each of which are incorporatedherein by reference.

A further example of a suitable pharmaceutical formulation is agel-matrix tablet, such as the products developed by PenwestPharmaceuticals (for example, under TimeRX). Suitable examples areprovided in U.S. Pat. Nos. 5,330,761, 5,399,362, 5,472,711 and5,455,046, the entire disclosures of each of which are incorporatedherein by reference. Particularly suitable is a retarding matrixformulation, with an inhomogeneous distribution of the pharmaceuticallyactive composition, whereby, for example, one component can bedistributed in the outer region (the portion that comes into contactwith the release medium most quickly) of the matrix and the othercomponent is distributed inside the matrix. On contact with the releasemedium, the outer matrix layer initially (and rapidly) swells andinitially releases the first component, followed by the significantly(more) retarded release of the other component. Examples of a suitablematrix include matrices with 1 to 80% by weight of one or morehydrophilic or hydrophobic polymers as pharmaceutically acceptablematrix formers. A further example of a suitable matrix may be inferredfrom U.S. Pat. No. 4,389,393, the entire disclosure of which isincorporated herein by reference.

The amount of the pharmaceutically active combination according to theinvention to be administered to the patient may vary depending ondifferent factors well known to those skilled in the art, for example,the weight of the patient, the route of administration, or the severityof the illness.

In another one of its aspects the present invention relates to acombination as described herein for the treatment of pain, wherein thepain is preferably selected from the group consisting of inflammatorypain, neuropathic pain, acute pain, chronic pain, visceral pain,migraine pain and cancer pain.

In a further aspect, the present invention relates to the use of apharmaceutical combination of the invention as described herein for thetreatment of pain, said pain preferably including, but not being limitedto, inflammatory pain, neuropathic pain, acute pain, chronic pain,visceral pain, migraine pain and cancer pain.

In another aspect, the present invention relates to the use of apharmaceutical combination of the invention as described herein for thepreparation of a medicament for the treatment of pain, said painpreferably including, but not being limited to, inflammatory pain,neuropathic pain, acute pain, chronic pain, visceral pain, migraine painand cancer pain.

In another aspect, the present invention relates to a method of treatingpain in a mammal, preferably a human, which comprises administering aneffective amount of an pharmaceutical combination of the invention asdescribed herein to the mammal.

The present invention also relates to a kit comprising a combination ordosage forms comprising a combination or individual components of thecombination.

Pharmacological Methods:

Randall-Selitto Test in Rats

The weight ratios of the components (a) and (b) that will lead to asupra-additive effect (synergistic effect) of the pharmaceuticalcomposition of the invention may be determined via the test of Randalland Selitto as described in Arch. Int. Pharmacodyn., 1957, 111: 409 to419, which is a test of mechanical nociception that may be adapted toevaluate mechanical hyperanalgesia in models of inflammatory orneuropathic pain. The respective part of the literature is herebyincorporated by reference and forms part of the present disclosure.

Acute inflammation is induced by an intraplantar injection of 0.1 ml ofa carrageenan-solution (0.5% in distilled water) into a hind paw of arat. The mechanical nociceptive threshold is measured 4 hours laterusing an Algesiometer (Ugo Basile, Italy). The device generates amechanical force with a linear increase over time. The force is appliedto the dorsal surface of the inflamed rat hind paw via a cone-shapedstylus with a rounded tip (2 mm tip diameter). The nociceptive thresholdis defined as the force (in grams) at which the rat vocalises (cut-offforce 250 g). The mechanical nociceptive threshold is measured atdifferent timepoints after the drug or vehicle administration. Theantinociceptive and/or antihyperalgesic activity of the tested substanceis expressed as percentages of maximum possible effect (% MPE). Thegroup size is n=12.

The analysis of the results with respect to a supra-additive effect ofthe pharmaceutical composition of the invention comprising thecomponents (a) and (b) is carried out via statistical comparison of thetheoretical additive ED₅₀-value with the experimentally determinedED₅₀-value of a so-called fixed ratio combination (isobolographicanalysis according to Tallarida J T, Porreca F, and Cowan A. Statisticalanalysis of drug-drug and site-site interactions with isobolograms. LifeSci 1989; 45: 947-961).

The interactions studies presented herein were performed usingequieffective doses of the two components, calculated from the ratio ofthe respective ED₅₀ values of the components if administered alone.

The route of administration was intravenous (i.v.) for(1R,2R)-3-(3-dimethylamino-1-ethyl-2-methyl-propyl)-phenol hydrochloride(hereinafter referred to as tapentadol hydrochloride) andintraperitoneal (i.p.) for ketamine ((R,S)-ketamine hydrochloride) andmemantine (memantine hydrochloride). When tapentadol hydrochloride wasapplied alone, the peak effect was reached 15 min p. appl. (timepoint offirst measurement) and an ED₅₀-value of 1.75 (1.69-1.81) mg/kg i.v. wascalculated. Ketamine hydrochloride induced a dose-dependent analgesiceffect with an ED₅₀-value of 20.2 (19.0-21.3) mg/kg i. p. respectively,reaching the peak effect 15 min p. appl. According to their respectivetimepoint of peak effect,(1R,2R)-3-(3-dimethylamino-1-ethyl-2-methyl-propyl)-phenol hydrochloridewas applied 15 min and ketamine hydrochloride 15 min before timepoint ofmeasurement of the interaction-experiments (both components were appliedsimultaneously). Memantine hydrochloride induced a dose-dependentanalgesic effect with an ED₅₀-value of 19.1 (17.0-22.0) mg/kg i. p.respectively, reaching the peak effect 15 min p. appl. According totheir respective timepoint of peak effect,(1R,2R)-3-(3-dimethylamino-1-ethyl-2-methyl-propyl)-phenol hydrochloridewas applied 15 min and memantine hydrochloride 15 min before timepointof measurement of the interaction-experiments (both components wereapplied simultaneously).

Thus, the time point of ED₅₀ calculation of both combinationscorresponded to the timepoint of the peak effect of the respectivecompound. The isobolographic analysis revealed that the experimentalED₅₀-values of the combinations were significantly lower than therespective theoretical ED₅₀-values. Thus, the combination studiesdemonstrated significant synergistic interaction of(1R,2R)-3-(3-dimethylamino-1-ethyl-2-methyl-propyl)-phenol hydrochloridewith the NMDA-antagonists, ketamine hydrochloride and memantinehydrochloride.

The results of the isobolographic analysis are summarized in thefollowing table. Experimental ED₅₀ values of tapentadol hydrochloride(A) and ketamine hydrochloride or A and memantine hydrochloride,respectively, and isobolographic analysis of the interaction between Aand these NMDA-antagonists:

tapentadol ketamine memantine Theoretical Experimental Substance/ hydro-hydro- hydro- ED₅₀ of the ED₅₀ of the ED₅₀ [mg/kg] chloride (A) chloridechloride combination combination Interaction tapentadol 1.75 20.2 — 11.09.2 supra- hydrochloride (1.69-1.81) (19.0-21.3) (10.6-11.3) (8.6-9.7)additive (A) + (p < 0.001) ketamine hydrochloride tapentadol 1.75 — 19.110.4 9.6 supra- hydrochloride (1.69-1.81) (17.0-22.0) (9.7-11.1)(9.0-10.2) additive (A) + (p < 0.05) memantine hydrochloride p: Level ofstatistical significance

The dose ratio of A to ketamine hydrochloride can be calculated to be1:11.5 and the dose ratio of A to memantine hydrochloride can becalculated to be 1:10.9.

The foregoing description and examples have been set forth merely toillustrate the invention and are not intended to be limiting. Sincemodifications of the described embodiments incorporating the spirit andsubstance of the invention may occur to persons skilled in the art, theinvention should be construed broadly to include all variations withinthe scope of the appended claims and equivalents thereof.

The invention claimed is:
 1. A pharmaceutical combination comprising ascomponents: (a) at least one stereoisomer of3-(3-dimethylamino-1-ethyl-2-methyl-propyl)-phenol compound of formula(I),

or a pharmaceutically acceptable acid addition salt thereof, and (b) atleast one NMDA-antagonist selected from the group consisting of(R,S)-ketamine, (S)-ketamine, and memantine.
 2. The combinationaccording to claim 1, wherein the compound of formula (I) orpharmaceutically acceptable acid addition salt thereof is selected fromthe group consisting of:(1R,2R)-3-(3-dimethylamino-1-ethyl-2-methyl-propyl)-phenol or apharmaceutically acceptable acid addition salt thereof, (1S,2S)-3-(3-dimethylamino-1-ethyl-2-methyl-propyl)-phenol or apharmaceutically acceptable acid addition salt thereof, (1R,2S)-3-(3-dimethylamino-1-ethyl-2-methyl-propyl)-phenol or apharmaceutically acceptable acid addition salt thereof, (1S,2R)-3-(3-dimethylamino-1-ethyl-2-methyl-propyl)-phenol or apharmaceutically acceptable acid addition salt thereof, and mixtures oftwo or more thereof in any mixing ratio.
 3. The combination according toclaim 2, wherein the compound of formula (I) or pharmaceuticallyacceptable acid addition salt thereof is selected from the groupconsisting of:(1R,2R)-3-(3-dimethylamino-1-ethyl-2-methyl-propyl)-phenol or apharmaceutically acceptable acid addition salt thereof,(1S,2S)-3-(3-dimethylamino-1-ethyl-2-methyl-propyl)-phenol or apharmaceutically acceptable acid addition salt thereof, and mixturesthereof in any mixing ratio.
 4. The combination according to claim 3,wherein the compound of formula (I) is(1R,2R)-3-(3-dimethylamino-1-ethyl-2-methyl-propyl)-phenol of formula(I′):

or a pharmaceutically acceptable acid addition salt thereof.
 5. Thecombination according to claim 4, wherein the compound of formula (I′)is the hydrochloride acid addition salt of(1R,2R)-3-(3-dimethylamino-1-ethyl-2-methyl-propyl)-phenol.
 6. Apharmaceutical dosage form comprising a combination according to claim 1and at least one pharmaceutically acceptable auxiliary agent.
 7. Adosage form according to claim 6, wherein said dosage form is suitablefor oral, intravenous, intraarterial, intraperitoneal, intradermal,transdermal, intrathekal, intramuscular, intranasal, transmucosal,subcutaneous, or rectal administration.
 8. A dosage form according toclaim 6, wherein at least one of the components (a) and (b) is presentin controlled-release form.
 9. A method of treating pain in a mammal inneed thereof, said method comprising administering to said mammal apharmacologically effective amount of a combination according toclaim
 1. 10. The method according to claim 9, wherein the pain isselected from the group consisting of inflammatory pain, neuropathicpain, acute pain, chronic pain, visceral pain, migraine pain and cancerpain.
 11. The method according to claim 9, wherein the pain isinflammatory pain.
 12. The method according to claim 9, whereincomponent (a) and component (b) of the combination are administeredsimultaneously to the mammal.
 13. The method according to claim 9,wherein component (a) and component (b) of the combination areadministered or sequentially to the mammal in either order.
 14. Themethod according to claim 9, wherein component (a) and component (b) ofthe combination are administered via different pathways ofadministration.
 15. The method according to claim 9, wherein component(a) and component (b) of the combination are administered via the samepathway of administration.
 16. A pharmaceutical combination comprisingas components: (a) the compound(1R,2R)-3-(3-dimethylamino-1-ethyl-2-methyl-propyl)-phenol of formula(I′):

 or a pharmaceutically acceptable acid addition salt thereof; and (b) atleast one NMDA-antagonist selected from the group consisting of(R,S)-ketamine, (S)-ketamine, and memantine.